Using Hermeneutic Phenomenology to Investigate How Experienced Practitioners Learn to Communicate Clinical Reasoning

Article excerpt

This paper is primarily targeted at doctoral students and other researchers considering using hermeneutic phenomenology as a research strategy. We present interpretive paradigm research designed to investigate how experienced practitioners learn to communicate their clinical reasoning in professional practice. Twelve experienced physiotherapy practitioners participated in this research. Using hermeneutic phenomenology enabled access to a phenomenon that is often subconscious and provided a means of interpreting participants' experiences of personal learning journeys. Within the philosophy underpinning hermeneutic phenomenology, researchers need to design a research strategy that flows directly from the research question and goals of the research project. This paper explores such a strategy. Key Words: Hermeneutic Phenomenology, Clinical Reasoning, Designing Research, and Professional Practice

Introduction

This paper explores the value of hermeneutic phenomenology as a credible and rigorous research approach to investigate learning of clinical reasoning and its communication in health professional practice. The research was part of Rola's doctoral research, with Joy as the principal supervisor. We have primarily targeted the paper at doctoral students and others considering hermeneutic phenomenology as a research strategy. In this paper we present the design of a research approach that encompasses a research paradigm and its philosophical assumptions and framework, the methodology, and the strategies used to gather data and derive meaning from these data. This is underpinned by criteria chosen to ensure quality in interpretive research; rigor (Lincoln & Guba, 2000) and credibility (Denzin & Lincoln, 2000; Koch & Harrington, 1998). In addition, attention is given to the ethical conduct of the research. Research findings are presented to enable readers to contextualize the research approach and to understand the connection between research design and outcome.

The Research Phenomenon and Questions

The researchers explored how experienced physiotherapists learn to communicate their reasoning within the complex context of health care settings in Sydney, Australia. The purpose was to uncover the practice and professional craft knowledge embedded in practitioners' practices, related to communication of clinical reasoning with patients and novice physiotherapists. In addition, the researchers sought to interpret participants' learning journeys and experiences. We have used the term "learning journey" to refer to the participants' learning experiences and the events, people, and situations that impacted on participants' learning of clinical reasoning and its communication. Clinical reasoning was defined in this research as the thinking and decision making associated with clinical practice (based on Higgs & Jones, 2000). Communicating reasoning includes explaining, articulating, or teaching the actual decisions and the thinking leading to the decisions (this includes decisions negotiated with the patient).

Clinical reasoning is a complex phenomenon. This complexity is related to reasoning processes within individuals that are both cognitive and interactive processes; are predominantly unobservable; at times automatic and subconscious; and always multifaceted and context-dependent (Higgs & Jones, 2000). Communication of clinical reasoning, while it is much more observable, is also embedded and enmeshed in practice, multifaceted, and is context-dependent. Learning in practice is situated and mostly implicit (Billett, 1996). Therefore, investigating the phenomenon of learning to communicate clinical reasoning required the participants to raise their level of awareness of their reasoning, their learning, and their communication, hence sub-questions related to each of these areas were explored.

The principal question of this research was: How do experienced physiotherapists learn to communicate clinical reasoning with patients and with novice physiotherapists? …